Shunts have found increased use in the treatment of traumatic vascular injuries and the like, particularly as a result of activities in Iraq and Afghanistan. In such circumstances, shunts are used to treat combat-related vascular injuries. Shunts in the arterial position allow for perfusion of the extremity during transport or fixation of associated orthopedic injuries. For injury patterns involving an artery and vein, shunts placed in the venous position provide drainage and decrease venous hypertension that can compound tissue ischemia and bleeding.
In many cases, shunts are used to treat vascular injuries resulting from improvised explosive devices, explosive munitions, high velocity weapons, and other high energy trauma. In such circumstances, shunts provide a damage control adjunct that can be applied at forward echelon locations to restore fluid flow and the like until such injuries can be treated more fully at medical treatment facilities.
The temporary shunts currently employed in these situations provide some advantages but suffer from several deficiencies. Reports from wartime and civilian medical centers confirm the effectiveness of temporary vascular shunting in the setting of vascular injury; however, these same reports describe random use of a number of devices, none of which are designed for treating vascular injuries. As such, currently available shunts are of suboptimal size, length, and diameter. Moreover, they have no capability for injection into the injured vessel and have no name recognition among trauma surgeons. Many of the currently used shunt technologies were designed and approved for use in carotid surgery for perfusion of the brain for a short period of time, rather than for temporary use in complex trauma-related vascular injury. They provide poor patency, and are not of comparable vessel size which leads to a reduction in efficacy, even for temporary use. As a result of these and other problems, the shunts currently used to treat traumatic vascular injuries are difficult to use and insert into damaged blood vessels. Similarly, in the case of the Vascutek® shunt that recently received FDA approval for use in trauma-related vascular injury, military surgeons report undesired complications because the shunt lacks the features necessary for appropriate trauma-related care. These limitations result, at least in part, from the fact that these shunts were not designed to treat traumatic vascular injuries. In aggregate, these deficiencies in technology generate the need for a trauma-specific extremity vascular shunt.